The possible repeal of the Affordable Care Act reintroduces a fear among people with pre-existing conditions of maintaining health insurance.

Under the ACA, pre-existing conditions were not counted against applicants seeking coverage through the state’s exchange, Covered California, but that could change if ACA is repealed and replaced under the Trump administration.

“There’s a lot of talk right now as to what’s going to happen if ACA is repealed,” Nicklas said. “The feds may be letting the states decide if they want to keep it or not. California is one of the states that incorporated what’s called an exchange so rather than just going off of healthcare.gov, they created their own nonprofit state funded exchange. A couple of other states interpreted the law how they wanted to as well.

Prior to ACA, insurers could deny coverage of individuals who were considered to be high-risk because of previously diagnosed conditions, Nicklas said.

Women typically had a more difficult time obtaining health insurance prior to the ACA, according to National Center for Health Research President Diana Zuckerman.

“Women applying for an individual health insurance policy had to answer a question if she’d ever had breast cancer, breast implants, or any other breast condition,” Zuckerman said. “When they first developed the test for the breast cancer gene mutation (BRCA1 and BRCA2 genes) a big problem was women who wanted to get tested where afraid they wouldn’t be able to get health insurance if they tested positive for the genes.”

Most health insurance companies also treated individual patients with pre-existing conditions differently than those that bought health insurance through large employers. This, according to Zuckerman, was what made it difficult for people to leave jobs where they had insurance.

Zuckerman said that prior to the ACA, a large majority of health insurance companies would either not sell insurance to people with pre-existing conditions, sell them insurance policies but not cover the pre-existing conditions, or sell them extremely expensive policies. Going without insurance would not be ideal due to the high cost of most medical procedures.

“The cost of treatments would be thousands of dollars that the vast majority of people do not have. People in those situations are just one hospitalization away from bankruptcy,” Zuckerman said. “None of the suggestions being made or proposed by Congress or the Trump team would be considered better by anybody with a pre-existing condition.”

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